The project, known as CHEERS - Coalition for Health Enhancement of Elders and Referral Services - provides student participation in a real-life, grassroots community project as part of the educational experience and has become a model within the state and region.

Local Area Agencies on Aging in fifteen counties in Northern Alabama refer clients to the program, and RN students then follow a caseload of five homebound elderly clients from their home counties. Over a period of one semester, these nurses go into the homes of clients, particularly in rural, isolated areas, and conduct screening, using an Elder Risk Appraisal instrument that was developed to assess specific risks for loss of independent living in this population. In response to the findings, the nurses provide education, needed services, and referrals. In addition, aggregate data are analyzed and these findings are then provided to the coalition in each county and used in health planning for this vulnerable elderly population. Thus far, over 1300 clients have been served and more than 500 nurses have been educated about the needs of the elderly. Analysis of outcomes indicates that this program has been a highly effective method for educating nurses about gerontological and community health nursing, as well as for meeting the needs of vulnerable elderly clients through collaboration between an educational institution and local service providers.

Data collected during the students' visits indicate that the needs of this population are startling and available resources are minimal. The benefits that these nurses have provided through this educational experience are astounding, as are the benefits provided to the students from the collaborative, interdisciplinary nature of the project. The College of Nursing is proud to work with these agencies toward the betterment of the entire older adult community.

Before visiting the clients a community survey is conducted to identify and evaluate local resources within each county. Health care access, emergency services, pharmacies, public transportation, and general businesses among others are identified.

After obtaining permission from each client the students identify individual problems using screening and interviewing techniques. Health status as well as social, financial, and environmental conditions which are known to threaten independent living are assessed. Bonding with the clients and establishing trust are major goals during the initial introductory phase and remain important throughout the entire process. The students assess each individual and, after determining needs, developed interventions to address all problem areas.

Many of the interventions involve teaching and making referrals to appropriate health care and social agencies. We carefully address how well the clients are managing their medical conditions in light of their understanding of the recommended treatments prescribed. Blood pressure, vision, and hearing screenings are performed.

Much teaching is directed toward increasing the clients' knowledge of medication taking practices. Nutritional education addressing dietary habits is provided and referrals are made, particularly under circumstances when clients cannot afford adequate food.

Environmental home safety risks are assessed including the presence of working smoke detectors, fire extinguishers and factors within the home that place an older person at risk for falling. To minimize risk, referrals are made to CASA (the Care Assurance System for Aging) and other local agencies that initiate necessary home improvements such as the building of ramps and installing hand rails.

Crime prevention is discussed with each client. We screen our clients for depression, loneliness, and availability of social support. Reminiscent therapy and horticultural therapy are incorporated into our visits to address the startling problem of depression and loneliness in the elders.

Of the services that we perform, possibly the most appreciated and critical to our clients is that of providing companionship. For many of our clients we are possibly the only people who routinely listen, talk, laugh, and cry with them. This experience offers a return to the basics. A return to the basics of nursing care. A return home.